In the past twenty years, researchers have shown the potential for virtual reality (VR) technologies to provide engaging and motivating environments for stroke rehabilitation interventions. Much of the research has been focused on the Exploratory Phase and jumps to Intervention Efficacy trials and Scale Up Evaluation have been made with limited understanding of the active ingredients in a VR intervention for stroke. The swiftness with which technology develops is an additional challenge for this emerging field, providing a moving target for researchers developing and evaluating potential VR technologies. Recent developments in customized games and cutting-edge technology used for VR are beginning to allow for researchers to understand and control aspects of the intervention related to motivation, engagement and motor control and learning. This paper argues for researchers to take a progressive, step-wise approach through the stages of intervention development using evidence-based principles, take advantage of the data that can be obtained, and use measurement tools in order to design effective VR interventions for stroke rehabilitation that can be assessed through carefully designed efficacy and effectiveness trials. This paper is motivated by the recent calls in the field of rehabilitation clinical trials research for carefully structured clinical trials that have progressed through the phases of research.